Health inequality is not a matter of lifestyle choice Reply

ASH Scotland has produced a manifesto for the 2016 Scottish Parliament elections. At the heart of this document, and the six calls it sets out for the next Scottish administration, are the fact that Scotland’s health inequalities are the widest in Western Europe, and our assertion that inequality is the greatest health challenge the next Scottish Parliament will have to address.

Smoking rates present a very clear example of this.

Tobacco use is highly determined by social and economic pressures and is a significant mechanism by which inequality translates into real harm to people and communities.

Smoking rates in the most deprived communities are four times higher than in the richest. Almost half of adults who are permanently sick or disabled, or who are unemployed and seeking work, smoke tobacco. Smoking rates are particularly high amongst people with mental health issues, the prison population and children in care.

As a consequence all of these groups suffer higher risk of cancer, dementia, stroke and heart disease. On average a smoker in Scotland spends £1500 a year on cigarettes, money that is often desperately needed elsewhere. The increased deaths from smoking often occur after many years of ill health, further debilitating deprived communities, and must lower the life expectations of those who grow accustomed to losing friends and family members at an early age.

Crucially, in every one of these groups most of those who smoke say that they want to stop. So the health, social and economic inequality caused by smoking is not about lifestyle choice but about people affected by social and economic factors which push some groups to smoke and make it more difficult for them to act on their desire to stop.

Understanding and addressing the factors underlying tobacco use will play an enormous part in reducing the harm caused by health inequality and improving well-being, particularly for vulnerable groups. Government policy and action should reflect the fact that tobacco use is rarely a simple, freely-made, lifestyle choice.

Scotland’s next administration should commit to concerted action across Government departments to protect children and support those wishing to quit, so that the only people who smoke are the small number of informed adults who actively choose to do so.


References for the various figures quoted in this article can be found on ASH Scotland’s election webpage.



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